VWR AU Manual De Instrucciones página 11

Decontamination Certificate continued...
Chemical Names:
(a)
(b)
(c)
(d)
Action to be taken in the event of
human contact:
(a)
(b)
(c)
(d)
Please complete relevant declaration below
Points a, b, c, d refer to individual substances. If substance is a mixture of various substances state
product name, complete form and ensure that product and Health and Safety data sheets are cross
referenced.
Should pumps have come into contact with body fluids, pathogens or microbial growth then a special
note shall be made on both, pump packaging and the form above.
Foregoing is equally applicable to related equipment.
I hereby confirm that the only toxic or
hazardous
equipment specified has pumped to come
into contact with are those named, and that
the information given is correct and the
carrier has
consignment is of a hazardous nature.
Signed:
Name:
Position:
Date:
Carrier to be used and delivery
VWR Return No:
Details of Substances Pumped and Contacted
Declaration
substance(s) that
been informed
date
Precautions to be taken in handling
these substances:
(a)
(b)
(c)
(d)
Cleaning fluid to be used if residue of
chemicals is found during servicing:
(a)
(b)
(c)
(d)
I hereby confirm that the equipment
the specified has not pumped nor come into
contact with any toxic or hazardous
substances.
Signed:
if the
Name:
Position:
Date:
Fault description or any other
Declaration
information
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